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RESP 201 FINAL
| Question | Answer |
|---|---|
| What is the primary purpose of the respiratory system? | continuous absorption of oxygen and excretion of carbon dioxide |
| Running vertically down each hemithorax anteriorly is an imaginary line that is used as an anatomical landmark. What is that line called? | Midclavicular Line |
| What is the function of the thorax? | Protects vital organs |
| What is the name of the external landmark that identifies the point at which the trachea branches into the right and left mainstem bronchi? | Angle of Louis |
| The intercostal arteries, veins, and nerves run through which of the following? | costal groove on the bottom of each rib |
| Which of the following muscles are considered primary muscles of ventilation? | The diaphragm and intercostal muscles |
| The diaphragm is innervated by which of the following nerves? | Phrenic nerve |
| The nerves that innervate the diaphragm arise from which area? | spinal nerves C3 to C5 |
| Which muscle is an accessory muscle of inspiration? | Scalene |
| Which muscle is an accessory muscle of expiration? | Internal Intercostals |
| Which accessory muscles are active during resting and active inspiration and pull up on all the ribs expanding the thorax? | external intercostals |
| Internal Intercostals | Which accessory muscles are active during resting and active exhalation and pull down on the rib cage and thereby push air out of the lungs? |
| ____________________ intercostals enlarge the thoracic cavity while _________________ intercostals compress it. | External, Internal |
| What is the function of the very small amount of pleural fluid that is found in the pleural space? | reduces friction |
| What forces establish the subatmospheric pressure found in the pleural space? | equal opposing tendency of the chest wall to expand(pull out) and lung to recoil (pull in) |
| The upper respiratory tract traditionally ends at what point? | inferior border of the larynx |
| What is the only complete circular cartilage of the larynx? | cricoid |
| Why do most aspirated fluids end up in the right mainstem bronchus instead of the left mainstem bronchus? | The right bronchus is more in line with the trachea |
| What intercommunicating channels permit collateral ventilation between adjacent alveoli and primary lobules? | Canals of Lambert and Pores of Kohn |
| Pulmonary surfactant is secreted by which type of lung cells? | Type II pneumocytes |
| In the trachea, what is needed to maintain airway patency to keep open cartilage ? | C-shaped cartilage rings |
| pump handle movement | Increase Anterior-Posterior(AP) Diameter |
| bucket handle movement | Increased lateral diameters |
| What is the name of the thin serous membrane that covers the lungs? | visceral pleura |
| What is the name of the thin serous membrane that covers the inner layer of the thoracic wall? | parietal pleura |
| What is the loose membranous sac that encloses the heart? | pericardium |
| Most of the muscle mass of the heart is located in which chamber? | Left ventricle (LV) |
| The mitral (bicuspid) valve does which of the following? | prevents left atrial backflow during ventricular contraction |
| Narrowing of the mitral valve (mitral stenosis) results in which of the following? | increased pulmonary congestion |
| Narrowing of the pulmonary valve (pulmonary stenosis) results in which of the following? | RV hypertrophy |
| What are the first arteries to branch off the ascending aorta? | coronary arteries |
| Before draining into the right atrium, where do the large veins of the coronary circulation gather together? | coronary sinus |
| Which of the following equations would you use to compute total peripheral resistance? | (mean aortic pressure - right atrial pressure) ÷ CO |
| Which of the following statements is true? a. Pulmonary vascular resistance (PVR) is equal to systemic resistance b. SVR is normally approximately 10 times higher than PVR | SVR is normally approximately 10 times higher than PVR |
| Which of the following formulas is used to calculate the total amount of blood pumped by the heart per minute, or cardiac output? | CO= HR x SV |
| What is an approximate normal resting cardiac output for a healthy adult? | 5000 ml/min |
| Which of the following factors determine cardiac stroke volume? | ventricular preload, afterload, contractility |
| P wave | atrial depolarization |
| The first heart sound is associated with what mechanical event of the cardiac cycle? | atrioventricular valve closure |
| The second heart sound is associated with what mechanical event of the cardiac cycle? | semilunar valve closure |
| Which of the following represent the normal order of structures encountered by blood flowing from the vena cava to the aorta? | Right Atrium, tricuspid valve, Right Ventricle, pulmonary valve, pulmonary artery, pulmonary veins, Left Atrium, mitral valve, Left Ventricle, aortic valve |
| The force or pressure that opposes ventricular contraction is called: | Afterload |
| what increases stroke volume: | Increase preload, Decreased afterload, Increased contractility |
| A small amount (2-3% of cardiac output) of venous blood normally mixes with arterial blood because of which of the following? 1. Congenital pulmonary defects 2. Bronchial venous drainage 3. Thebesian venous drainage in the heart | Bronchial venous drainage and Thebesian venous drainage of the heart |
| Primary function of the lungs | gas exchange |
| __________________ measures the distensibility of the lung | compliance |
| How is lung compliance (CL) measured? | change in volume/change in pressure |
| A fibrotic lung would exhibit which of the following characteristics? | decrease lung compliance |
| A lung that loses elastic fibers (as in emphysema) would exhibit which of the following characteristics? | increased pulmonary compliance |
| The presence of surfactant in the alveoli tends to do which of the following? | decrease surface tension |
| Which of the following statements about alveolar pressure (Palv) during normal quiet breathing is true? | It is negative during inspiration and positive during expiration |
| Which of the following pressures normally remains negative (relative to atmospheric pressure) during quiet breathing? | Pleural pressure (Ppl) |
| In individuals with disorders characterized by an increased frictional work of breathing, such as emphysema, which of the following breathing patterns results in the minimum work? | Slow and deep breathing |
| low blood carbon dioxide level (decrease in PaCO2) | hyperventilation |
| elevated blood carbon dioxide level | hypoventilation |
| At equilibrium, the chest wall is pulled outward while the lung is pulled inward, thus producing the normal subatmospheric ________________. | intrapleural pressure |
| What causes work of breathing (WOB)? | Decreased chest wall compliance, Decreased lung compliance, Increased airways resistance |
| The apex of the upright human lung compared with the base has: | A higher PO2 |
| which of the following would you expect to occur if ventilation to an area of the lung remained constant but perfusion to this same area decreased? I. The PACO2 should fall II. The PAO2 should fall III. The V/Q ratio should rise | The PaCO2 should fall The V/Q ratio should rise |
| Which of the following would you expect to occur if perfusion to an area of the lung remained constant, but VA to this same area decreased? | The PaO2 should fall |
| Which of the following pressures vary throughout the normal breathing cycle? | alveolar pressure (Palv) & pleural pressure (Ppl) |
| High V/Q ratio is in the apex or the bases? | Apex |
| Low V/Q ratios is in the apex or base of the lungs? | Bases |
| Ventilation is high in the apex or bases? | ventilation is high in apex |
| Blood flow is higher in the apex or bases? | blood flow is high in bases |
| Regional factors affecting the distribution of gas in the normal lung result in which of the following? | More(increase) ventilation goes to the bases and lung peripheries |
| Equal Pressure Point (EPP) | Pressure inside airway= Pressure outside the airway |
| At resting breathing, the Pao (airway opening pressure) is less, greater, or equal to Palv (alveolar pressure)? | equal to |
| Alveolar ventilation (VA) pressure | 4 L |
| EF (ejection fraction) | SV/EDV (%) |
| VE (minute ventilation) | VT x RR |
| VA (alveolar ventilation) | (VT - VD) x RR |
| SVR (systemic vascular resistance) | (MAP-RAP)/CO |
| PVR (pulmonary vascular resistance) | (MPAP-LAP)/CO |
| VD/VT (physiological dead space) | (PaCO2 - PECO2) / PaCO2 |
| During expiration, why does gas flow out from the lungs to the atmosphere? | Palv is greater than at the airway opening |
| Which of the following statements are true about pressure differences in the upright lung? 1. Ppl increases from lung apex to base 2. The apical alveoli resting volume is less at the base 3. The transpulmonary pressure gradient is greatest at the apex | Ppl increases from lung apex to base & The transpulmonary pressure gradient is greatest at the apex |
| Which of the following occurs during normal inspiration? | Alveoli at the apexes expand less than those at the bases |
| Tiny air sacs for gas exchange | alveoli |
| place where trachea splits into R+L | carina |
| microscopic airway hairs that sweep mucus up and out of the lungs | cilia |
| primary muscle for breathing | diaphragm/intercostal |
| leaf-shaped cartilage that covers airway during swallowing | epiglottis |
| hole that opens into your windpipe | glottis |
| point where vessels and nerves enter the lung | hilum |
| voice box | larynx |
| throat common passageway for digestive and respiratory tract | pharynx |
| wrapping that lines the lungs | pleural |
| breastbone | sternum |
| trachea | windpipe |
| What does the Frank-Starling law of the heart state? | The more cardiac fibers stretch, the greater the stroke volume (the greater the stretch, the stronger the contraction) |
| which of the muscles below when stimulated will contract and push up on the diaphragm? | external intercostals, external obliques, internal obliques |
| Which of the following muscles are considered primary muscles of ventilation? | diaphragm, intercostals |
| what pulmonary disorder can lead to acute flattening of the diaphragm? | Asthma |
| What is the lowest level on the spinal cord that an injury could cause diaphragmatic impairment or paralysis? | C3 |
| Which of the following is the most important ventilatory function of the scalene muscles? | lift upper chest particularly during times of high ventilatory demand |
| What is the mediastinum? | structure separating the right and left thoracic cavities |
| Hypoventilation is defined as: | elevated blood carbon dioxide level |
| The pulmonary arterial circulation does which of the following? | delivers unoxygenated blood to the lungs, originates on the right side of the heart |
| What is the function of the thorax? | protects vital organs |
| The diaphragm is innervated by the: | phrenic nerve |
| What are parts of the sternum? | manubrium, body, xiphoid process |
| What is meant by “internal respiration”? | exchange of gases between the blood and the tissue |
| Which of rib pairs connect directly to the sternum? | 1-7 |
| A patient has a C2 fracture. Which muscle is affected by this injury? | diaphragm |
| The mitral valve does which of the following? | prevents left atrial backflow during ventricular contraction |
| The pulmonary semilunar valve does which of the following? | prevents backflow of blood to the ventricle during ventricular relaxation |
| What are the first arteries to branch off the ascending aorta? | coronary arteries |
| What are the major branches of the left coronary artery? | anterior descending, circumflex |
| Tissue layers making up the heart wall include which of the following? | epicardium, myocardium, endocardium |
| What is the loose membranous sac that encloses the heart? | pericardium |
| A small amount (2-3% of cardiac output) of venous blood normally mixes with arterial blood because of which of the following? | bronchial venous drainage, Thebesian venous drainage in the heart |
| ____________ is a pathologic narrowing or constriction of a valve outlet, which causes increased pressure in the proximal chamber and vessels. | stenosis |
| The degree of precontraction stretch of the heart is known as _________. | preload |
| The force or pressure that opposes ventricular contraction is called __________. | afterload |
| What is the term for the volume of blood remaining in the ventricles just prior to contraction? | End-diastolic volume (EDV) |
| The total volume moving in or out of the lungs per minute is called: | minute ventilation |
| If a patient has a tidal volume (VT) of 400 ml, residual volume (RV) of 1000 ml, and a respiratory rate of 12 breaths per minute, what is the minute ventilation (VE)? | 4.8 L/min |
| What is gas that is wasted during normal ventilation called? | dead space ventilation |
| The volume of the conducting airways that does NOT participate in gas exchange is called _______________________. | anatomic dead space |
| Hypoventilation is defined as: | elevated blood carbon dioxide level |
| What is the normal increase in ventilation that occurs with increased metabolic rates called? | hyperpnea |
| What term is used for ventilation that is in excess of metabolic needs and results in decreased PaCO2? | hyperventilation |
| What does the central venous pressure (CVP) represent? | Filling pressure of the right atrium |
| A normal 150-lb man is breathing at a rate of 20 with a tidal volume of 450 ml. By estimation, what is his approximate alveolar ventilation? | 6 L/min |
| What is the compliance of the lung (CL) if pt's inspired volume is 2 L at the 10 cm H2O of inflation pressure? | 0.2 L/cm H2O |
| The apex of the upright human lung compared with the base has: | A higher PO2 |
| In a normal individual lying on the right side (right side down), which of the following conditions would be true? | The right lung would receive the most ventilation. |
| In a healthy person, hypoxemia does NOT increase the drive to breathe until the PaO2 drops below _____ mm Hg. | 60 |
| J-Receptors are named from ____________________. | Juxtacapillary |
| The breathing of patients with severe COPD may be driven by mostly _______ stimulus. | hypoxic |
| The central chemoreceptors are sensitive to the _______ but not _______ of blood. | PCO2, PO2 |
| The control of breathing is regulated by the ________ and ________ of the brainstem. | medulla, pons |
| The peripheral chemoreceptors are located in the ________ and ________ bodies. | carotid, aortic |
| What is NOT a cause of apneustic breathing? | Asthma |
| What is not a function of the pneumotaxic center? | Prolongs the inspiratory phase. |
| What is the effect when the deflation reflex is stimulated? | a strong inspiratory effort |
| What receptors are associated with causing coughing, sneezing, and tachypnea when stimulated? | irritant receptors |
| Which of the following can cause laryngospasm and bradycardia through a vagovagal reflex? I. bronchoscopy II. endotracheal intubation III. tracheal suctioning | I, II, and III |
| __________ directly stimulates the central chemoreceptors. | H+ |
| About 90% of the CO2 that enters the blood diffuses into the red blood cells. Which doesn't belong to the mechanisms of the CO2 transport? | Combines with chloride ion (Cl-) |
| At sea level, the inspired PO2 (PiO2) in ambient air after adjusting for PH2O is: | 150 mm Hg |
| At sea level, the partial pressures of O2 in alveoli (PAO2) is: | 100 mm Hg |
| Fick’s law for diffusion states that the amount of gas that moves across the A-C membrane is: | - directly proportional to the surface area of the membrane - directly proportional to the diffusion coefficient. - directly proportional to the pressure gradient. - inversely proportional to the thickness of the membrane. |
| The impact of changes in blood pH on Hb affinity for oxygen, e.g., decreased Hb affinity for O2 as CO2 diffuses into the blood at the tissue level, is called __________ effect. | bohr |
| The lowest PO2 would normally be found in what location? | cells |
| The sum of oxygen dissolved and chemically combined with Hb is called ____________________. | total oxygen content |
| What happens when the oxyhemoglobin dissociation curve (ODC) shifts to the right? | The Hb affinity for O2 decreases. |
| When is the rate of gaseous diffusion across a biological membrane decreased? | The partial pressure gradient is low. |
| Which does NOT belong to the methods to increase PAO2? | By increasing respiratory rate |
| Which is NOT a factor that affects oxygen loading and unloading and causes a shift of the Hb-O2 dissociation curve? | Blood glucose |
| Which of the following decreases the affinity of Hb for oxygen? | increased temperature |
| A decrease in the H+ ion concentration of the blood caused by a low PaCO2 best describes which of the following? | respiratory alkalosis |
| What factor would limit the ability of the H2CO3/ HCO3- buffer system to perform efficiently? | lungs failing to excrete adequate levels of CO2 |
| Which arterial blood gas reading is used to indicate the respiratory component of the acid-base state? | PCO2 |
| H2CO3 is also called volatile acid because the lungs eliminate it as ___________ | CO2 |
| ____________ usually occurs when there is a loss of fixed acids or a gain in blood buffer base. | metabolic alkalosis |
| Volatile acids are eliminated through the: | Lungs |
| If a patient is having a problem related to acid-base balance, which two organs are most likely to be affected? | Lungs and kidneys |
| When referring to a patient’s acid-base balance, the respiratory therapist is assessing: | The physiologic mechanisms that regulate the concentration of hydrogen ions [H+] in the blood and body fluids. |
| Which is NOT a common causes of Respiratory Acidosis? | Anxiety |
| The primary chemical event in metabolic alkalosis is the increase in blood _______ levels. | HCO3- |
| The primary chemical event in respiratory acidosis is the increase in blood _____ levels. | CO2 |
| Compensation for metabolic acidosis occurs through which of the following? | decrease in blood CO2 levels |
| Compensation of respiratory acidosis is accomplished by which of the following? | renal excretion of HCO3- |
| An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3- of 18 mEq/L. What compensatory measure has the body taken to at least partially compensate for the acid-base disorder? | blown off CO2 |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.51, PCO2 = 42 mm Hg, HCO3- = 38 mEq/L | acute (uncompensated) metabolic alkalosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 6.89, PCO2 = 24 mm Hg, HCO3- = 4.7 mEq/L | partially compensated metabolic acidosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.08, PCO2 = 39 mm Hg, HCO3- = 11.8 mEq/L | acute (uncompensated) metabolic acidosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.28, PCO2 = 53 mm Hg, HCO3? = 25.8 mEq/L | acute (uncompensated) respiratory acidosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.36, PCO2 = 68 mm Hg, HCO3- = 34.3 mEq/L | fully compensated respiratory acidosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.38, PCO2 = 21 mm Hg, HCO3- = 11.7 mEq/L | fully compensated metabolic acidosis |
| Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.42, PCO2 = 21 mm Hg, HCO3- = 13.7 mEq/L | fully compensated respiratory alkalosis |
| In which of the following conditions is total lung capacity (TLC) always reduced? | restrictive lung disease |
| To ensure validity of the forced vital capacity (FVC) measurement, how many attempts should the patient perform? | three that are acceptable |
| What is required to determine the predicted values when performing a PFT? | Patient height, age, gender, and ethnicity |
| What is the gas normally used to measure the diffusing capacity of the lung? | CO |
| What is the primary problem in obstructive lung disease? | increased airway resistance |
| What is the sum of the residual and the expiratory reserve volume? | Functional residual capacity |
| When used to determine functional residual capacity, the body plethysmography operates on which of the following physical principles? | Boyle’s law |
| Which doesn't measure a volume? | FEF25-75 |
| Which is not an indication for spirometry? | Measure oxygen concentration |
| Which of the following is typically elevated in restrictive lung disease? | pressure needed to expand the lung |
| Which of the following statements is FALSE regarding measurement of the patient’s forced vital capacity (FVC)? | Accurate results can be obtained without patient cooperation. |
| Which of the following techniques is NOT used to measure FRC? | flow-volume loops |
| When evaluating a forced vital capacity maneuver post-bronchodilator use to determine the reversibility of any airway obstruction, what percent increase in FEV1 is needed to be able to say the treatment was effective? | 15% |
| Which of the following is a false statement regarding validity of spirometry test? | Each patient must perform at least one acceptable FVC maneuvers. |
| Which of the following volumes or capacities cannot be measured by simple spirometry? I - functional residual capacity (FRC) II - expiratory reserve volume (ERV) III - residual volume (RV) IV - inspiratory reserve volume (IRV) | I and III |
| Which of the following is equal to total lung capacity (TLC)? | VT + ERV + IRV + RV |
| Which of the following is a TRUE statement? | VC = IRV + VT + ERV |
| Which of the following techniques is NOT used to measure residual volume? | flow-volume loops |
| A patient has a vital capacity (VC) of 4200 ml, a functional residual capacity (FRC) of 3300 ml, and an expiratory reserve volume (ERV) of 1500 ml. What is the residual volume (RV)? | 1800 ml |
| During a helium dilution test for functional residual capacity, you notice that it takes 19 minutes for equilibration between the gas concentrations in the spirometer and the patient’s lungs. Based on this information, what can you conclude? | The patient has obstructive lung disease. |
| The DLCO would be decreased in all of the following except: | secondary polycythemia |
| 41-year-old man “occasional smoking” reveals no past history of pulmonary problems? SPIROMETRY: FVC(86% pred), FEV1 (85% pred), %FEV1 (73% pred), FEF25%-75% (54% pred). LUNG VOLUME: TLC (95% pred), FRC (107% pred), RV (108% pred), VC (94% pred). | small airway obstruction |
| 32-year-old 53-kg woman admitted for elective surgery? SPIROMETRY: FVC (63% pred), FEV1(58% pred), %FEV1 (82% pred), FEF25%-75%(112% pred). LUNG VOLUME: TLC(67% pred), FRC(55% pred), RV (55% pred), VC (64% pred). | restrictive lung disorder |
| 67-year-old, 76-kg man admitted for pulmonary complications? SPIROMETRY: FVC 3.24L (66% pred), FEV1 2.22L (72% pred), %FEV1 (67% pred), FEF25%-75% 2.67L/sec (78% pred). LUNG VOLUME: TLC (67% pred), FRC (70% pred), RV (75% pred), VC (76% pred). | combined disease process. |
| Alveolar Oxygen Tension (PAO2) | (PB – 47) x FIO2 – (PACO2/0.8) |
| P[A−a]O2 (A-a gradient) | PAO2 – PaO2 |
| a/A ratio | PaO2/PAO2 |
| Total O2 Content (CaO2) | (0.003 x PAO2) + (Hb x 1.34 x SaO2) |
| What are the 3 types of lung volume tests? | -He dilution -N2 washout -body box (plethysmography |
| TLC<80% | restrictive lung disease |
| FEV1% <70% | obstructive lung disease |
| RV | = (FRC - ERV), = (TLC - VC) |
| FRC | = (ERV + RV), = (TLC - IC) |
| VC | = (IRV + Vt + ERV), = (TLC - RV) |
| TLC | = (VC + RV) , = (IC + FRC) , = (VT + ERV + IRV + RV) |
| What are parts of the sternum? | manubrium, body, xiphoid process |
| Where is the sternal angle located? (angle of louis) | at the join between the manubrium and sternal body |
| You notice that a patient is contracting the diaphragm during exhalation. What does this finding indicate? | The patient is exhaling actively. |
| Which of the following is NOT a primary function of the nasal cavity? | gas exchange |
| What are the three bony projections that arise from the lateral walls of the nasal cavity that enhance filtration and humidification? | turbinates |
| Into what structure do the eustachian tubes drain? | nasopharynx |
| What is the cartilage that is commonly referred to as the Adam’s apple? | thyroid |
| What portion of the left lung corresponds anatomically to the middle lobe of the right lung? | lingula |
| What is the common name given to classify the airway from the nares to the terminal bronchioles? | conducting airways |
| What is the major source of respiratory tract secretions in the normal lung? | bronchial glands |
| What is the name given to the action produced by the forward stroking of millions of cilia? | mucociliary escalator |
| The apex of the heart lies just above the diaphragm at a level corresponding to which intercostal space? | fifth |
| What does the QRS complex represent in EKG? | Contraction of the ventricles |
| The inability of the heart to pump blood is called __________. | Systolic dysfunction |
| Which of the following waves represents repolarization of the ventricles? | T waves |
| Since afterload is not easily quantified, ___________ is used as a reasonable estimate of afterload. | Mean arterial blood pressure |
| The inability of the heart to pump because of impairment in the frequency of contractions is known as _____________. | Arrhythmia |
| Which is NOT a factor affecting stroke volume (SV)? | Conductivity |
| Which of below does NOT increase stroke volume? | Decreased preload |
| How is airway resistance (Raw) computed? | change in pressure/flow |
| The lungs have a tendency to recoil inward, whereas the chest wall tends to move outward. The point at which these opposing forces balance is called _______________________. | Functional residual capacity |
| What is the intrapleural pressure at the end of normal (tidal) expiration relative to atmospheric pressure? | −5 cm H2O |
| Which is NOT a cause of increased work of breathing (WOB)? | Increased airway flow |
| what is the alveolar air equation? | PAO2 = (760– 47) x FIO2 – (PACO2/0.8) |
| Total Oxygen Content of Blood (CaO2) equation | CaO2 = (0.003 x PaO2) + (Hb x 1.34 x SaO2) |
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